3D打印钛合金骨小梁金属臼杯、垫块在全髋关节置换翻修术中的应用

Application of titanium bone trabecular metal acetabular cup and pad by 3D printing technology in hip revision procedures

目的探讨3D打印钛合金骨小梁金属(TTM)臼杯、垫块在全髋关节置换翻修术中的应用疗效。方法笔者自2014-01—2014-12对15例单侧髋关节置换术后患者进行翻修。关节髋臼侧翻修原因:髋关节无菌性松动10例,习惯性脱位5例。均采用3D打印钛合金TTM臼杯、垫块对假体进行单侧翻修,而双下肢平衡及偏心距均通过假体柄及颈的长度来调节。结果 15例均获得随访12~18(13.6±2.2)个月。髋关节Harris评分:术前(43.9±10.3)分,术后6个月(80.5±4.6)分,末次随访(85.1±5.2)分,末次随访Harris评分与术前、术后6个月比较均有改善,差异有统计学意义(t=281.96,P<0.001;t=30.10,P<0.001)。VAS评分:术前(4.4±1.7)分,术后6个月(0.9±0.8)分,末次随访(0.7±0.8)分,末次随访VAS评分与术前比较有较大改善,差异有统计学意义(t=463.93,P<0.001)。术后无一例出现翻修失败,假体与机体骨交界处有连续性骨小梁通过。患者下地行走步态良好,随访期间无假体脱位、松动及髋关节异常疼痛影响行走,末次随访患髋屈曲均能达到90°,能满足日常生活需要并能正常行走、下蹲。结论全髋关节置换翻修术应用3D打印钛合金TTM臼杯、垫块的初始稳定性好、早期骨长入良好,短期疗效满意,长期疗效有待于进一步随访。

Objective To investigate the application of titanium trabecular metal （TI＇M） acetabular cup and pad by 3D printing technology in hip revision procedures after total hip arthroplasty（THA）. Methods Fifteen patients（15 hips） received revision after unilateral total hip arthroplasty from January 2014 to December 2014. The reasons of acetabular revision were aseptic loosening in 10 cases and habitual hip dislocation in 5 cases. All patients underwent unilateral aeetabular revision with titanium bone trabecular metal acetabular cups and pads made by 3D printing technology. The problems of the balance of both lower limbs and the eccentricity could be handled by adjusting the length of the prosthetic handle and neck. Results All the 15 patients were iollowed up for （13.6±2.2）months （12-18 months）. Harris hip scores were （43.9±10.3）points preoperatively, （80.5±4.6）points 6 months after the surgery, （85.1±5.2）points of the last follow-up. The Harris scores of the last follow-up were improved compared with that before operation and 6 months after surgery, the difference was statistically significant （t=281.96, P 〈0.001; t=30.10, P 〈0.001）. VAS scores were （4.4±1.7） points preoperatively, （0.9±0.8）points 6 months after the surgery, （0.7±0.8）points of the last follow-up. The VAS scores of the last follow-up was improved compared with that before operation, the difference was statistically significant （t =463.93, P 〈0.001）. There was no case of revision failure. The X-ray showed strong evidence of trahecular bridging between the bone graft and the host bone. The gait of the patients recovered to normal, and their walking was not ＇affected by prosthetic dislocation or loosening or abnormal hip pain during the follow-up. At 1 year after the operation, the hip flexion angel reached more than 90°. The patients could complete daily activities, and even squat. Conclusion In hip revision ＇after THA, the initial stability of TTM acetabular cup produced by 3D printing technology is fine, which can facilitate bone ingrowth in early stage. However, the long term tbllow-up effect still needs to be confirmed.